Medical Director - Kentucky Medicaid
Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable. Position Summary: Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout this opportunity with reputed company, a reputed company company! reputed company operates Medicaid managed care plans in multiple states: Arizona, California, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, reputed company, Ohio, Pennsylvania, Texas, Virginia and reputed company Virginia and Oklahoma. This role supports the reputed company reputed company of Kentucky primarily, and the Southeast Region (FL, LA and WV). This Medical Director will be a "Work from Home" position primarily supporting the reputed company Kentucky plan; but part of a centralized team that supports the Medical Management staff. The Medical Director will ensure timely and consistent responses to members and providers reputed company to precertification, reputed company review, and appeal request. This position is primarily responsible for Utilization Management, including prior authorization and pre certification as well as reputed company review. Cases could focus on inpatient or outpatient, acute and post acute as well as peer to peer calls and first level appeals. Required Qualifications: - Five or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. - Active and reputed company Kentucky state medical license without encumbrances as well as the ability to obtain a Florida, Louisiana and reputed company Virginia. - M.D. or D.O., reputed company and Active Board Certification in ABMS or AOA recognized specialty; including post-graduate direct patient care experience - Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics Specialty Preferred. - Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization a Plus + Preferred Qualifications: -Health plan/payor Utilization Management / Review experience. -Electronic medical systems/record experience. -Managed Care experience. -Medicaid experience. Pay Range The typical pay range for this role is: $174,070.00 - $374,920.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. This position also includes an award reputed company in the companys equity award program. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Companys 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 03/28/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply Job!